North Carolina Pharmacy Improves Patient Care Via Flip the Pharmacy Program

Amanda Harmon, PharmD, BCGP, BCADM, is a pharmacist at Gates Pharmacy in Mount Airy, North Carolina. A graduate of Campbell University College of Pharmacy & Health Sciences in Buies Creek, NC, Harmon gained her experience and clinical knowledge working in an independent pharmacy and as a consultant for long-term care facilities, before joining the team at Gates Pharmacy.

In September 2019, Harmon’s team filled out a qualifying survey to participate in the Flip the Pharmacy program, a 2-year transformation program where pharmacists learn how to provide enhanced clinical services. The program is a collaboration between the Community Pharmacy Foundation and CPESN. In October, Gates Pharmacy was accepted into the program.

“We were excited for this great opportunity to have someone to guide us on the implementation of clinical services,” Harmon said.

With Flip the Pharmacy, Harmon explains, every month the pharmacy receives a Change Package with a specific focus, that builds on previous months.

“With the help of our in-person coaching, we are gradually building the services we provide,” Harmon said.

Currently, the team at Gates Pharmacy is working on month five of the program, which involves documentation, using e-care coordination notes (Harmon’s team uses a program called PrescribeWellness) and care coordination notes.

A common example, Harmon explains, is a non-compliant patient. “We don’t want to have to add more medications to a patient who is already non-compliant,” she said.

Harmon types a letter on the pharmacy’s letterhead, and her pharmacy technician, Verona, faxes the letter to the doctor. If there is no response in several days, then the pharmacy will follow up with the physician.

The letter can be short and simple, Harmon explains.

“I met with Mr. Smith today, and these are my concerns and recommendations.”

The reactions of the doctors have been positive. “The answer may not always be a yes,” Harmon said, “but if the doctor reads it and signs it, it’s a win. They know we are really involved in patient care.”

She emphasizes that the goal is to make the doctor aware of the patient’s needs, and that the pharmacists are always available to discuss problems and solutions.

As most pharmacy personnel are well aware, excellent patient care is a team effort. Harmon acknowledges that her team is essential to the success of the program. Working with colleagues Hayley Wood, PharmD, MBA, and the pharmacy owner, Neil Edlen, PharmD, as well as a problem-solving technician, Verona Marsh, CPhT, and a group of technicians and customer service representatives, Harmon refers to her team as “the best I’ve ever worked with, they are eager to help patients.”

Harmon explains how patient care via Flip the Pharmacy is a team effort. Assisting the pharmacy’s 80% of patients on the medication sync program is a huge task, but made manageable through organized teamwork. First, a technician calls the patient prior to filling that patient’s prescriptions. This gives the technician the opportunity to review the medication list with the patient, and ask questions. Has the patient had a doctor visit? Are there any medication changes? Has the patient missed doses of medication?

Next, when the patient arrives to the pharmacy, a customer service representative completes a short questionnaire with the patient, and refers the patient to the pharmacist, if necessary. The customer service representative also offers to take the patient’s blood pressure at every visit. As part of the Flip the Pharmacy program, Harmon explains, at least one staff member (not a pharmacist) is trained to take blood pressure.

Harmon’s staff completes Target: BPTM training through the American Heart Association and American Medical Association, which has a full online training course, and then on-the-job practice. Patients are also encouraged to stop into the pharmacy anytime for a blood pressure check.

Taking blood pressure is an extremely valuable service a pharmacy can easily provide, Harmon says. She tells of a time when a patient came in, and mentioned she had tingling in the left arm. Hayley Wood was the pharmacist on duty. The patient's blood pressure was taken, and was very high.

Wood referred the patient to the ER for evaluation. The patient stopped back into the pharmacy soon after, expressing gratitude to the team for their help. The patient is part of the medication sync program, but had been noncompliant. Now, the patient is doing much better, and has become more compliant, and the team sees her every month to ensure compliance.

If you are considering participating in Flip the Pharmacy, but are wondering how you will have time to incorporate the challenges into your workday, Harmon reassures pharmacists that, “it is not a huge amount of extra work. Everyone has a role, many issues are identified by a technician or customer service representative. Working as a team is essential.” In fact, Harmon asks the technicians for suggestions and feedback, which technicians appreciate.

“A pharmacy cannot be successful without the technicians,” Harmon said.

Additionally, Harmon says, there is plenty of support. She meets with her Flip the Pharmacy coach, Patrick Brown, every month to discuss any issues or concerns. He keeps her informed of what is coming in future months. This guidance helps Harmon and her team brainstorm ahead of time, as well as feel supported on a day-to-day basis.

Harmon stresses the importance of being proactive about talking to the patients, and providing counseling. She finds it helpful to provide various counseling cards. For example, blood pressure patients receive a card with information on smoking cessation programs, as well as a log to record blood pressure readings. She finds that her patients take it very seriously, and are appreciative of the excellent quality of patient care provided by the pharmacy team.

Harmon’s call to action: “Get involved - we are equipped for this. This is a great opportunity for pharmacists to serve patients with an even better level of care. Train and involve the whole team - it’s all for the patient.”